ATI Maternal Newborn exam maltoso
Total Questions : 23
Showing 23 questions, Sign in for moreA student nurse is reviewing the Five P's of labor and how they can affect labor dystocia.Which of the following fetal (passenger) factors can contribute to labor dystocia?
Explanation
Choice A rationale
Fetal polydactyly is the presence of extra fingers or toes. This condition does not affect the progress of labor or lead to dystocia, as it doesn't impact the size, position, or descent of the fetus through the birth canal.
Choice B rationale
The occiput anterior cephalic position is the ideal fetal position for labor. It allows the widest part of the fetal head to fit through the pelvis most easily, reducing the likelihood of labor dystocia.
Choice C rationale
An estimated fetal weight of 4600 grams (macrosomia) can lead to labor dystocia. A larger fetus may have difficulty passing through the maternal pelvis, causing obstructed labor.
Choice D rationale
Fetal hydronephrosis refers to the swelling of the kidney due to urine buildup. While this can be a significant health concern, it does not typically impact the labor process directly.
A student nurse is reviewing the Five P's of labor and how they can affect labor dystocia.Which of the following fetal (passenger) factors can contribute to labor dystocia?
Explanation
Choice A rationale
Fetal polydactyly is the presence of extra fingers or toes. This condition does not affect the progress of labor or lead to dystocia, as it doesn't impact the size, position, or descent of the fetus through the birth canal.
Choice B rationale
The occiput anterior cephalic position is the ideal fetal position for labor. It allows the widest part of the fetal head to fit through the pelvis most easily, reducing the likelihood of labor dystocia.
Choice C rationale
An estimated fetal weight of 4600 grams (macrosomia) can lead to labor dystocia. A larger fetus may have difficulty passing through the maternal pelvis, causing obstructed labor.
Choice D rationale
Fetal hydronephrosis refers to the swelling of the kidney due to urine buildup. While this can be a significant health concern, it does not typically impact the labor process directly.
A nurse is caring for a client who is in the second stage of labor.The nurse observes the umbilical cord protruding from the vagina.Which of the following actions should the nurse perform first?
Explanation
Choice A rationale
Protrusion of the umbilical cord from the vagina is a medical emergency known as umbilical cord prolapse. It is not an expected finding and requires immediate intervention to prevent fetal hypoxia.
Choice B rationale
Inserting a gloved hand into the vagina to elevate the presenting part is the correct immediate action. This helps relieve pressure on the umbilical cord and maintain blood flow to the fetus until more definitive interventions can be performed.
Choice C rationale
Encouraging the client to push would increase pressure on the umbilical cord and can lead to reduced oxygen supply to the fetus, worsening the situation.
Choice D rationale
Placing the client in a lateral position might help to some extent, but it is not the primary or most effective intervention for umbilical cord prolapse. Immediate manual elevation of the presenting part is required.
A nurse is caring for a client in labor that has been struggling with hypotonic uterine dysfunction.Throughout labor the client's plan of care included oxytocin titration, amniotomy, and IUPC placement.Despite adequate contractions (Montevideo units over 200 mmHg) for many hours, there has been no cervical change and cervix remains 7 cm, 75% effaced, and fetal station of minus (-) 2. The provider tells the patient she believes there is a cephalopelvic disproportion (CPD). What recommendation does the nurse anticipate the provider will discuss next?
Explanation
Choice A rationale
Vacuum-assisted delivery is typically used when there is some progress in the labor process and the fetal head is engaged. In cases of cephalopelvic disproportion, vacuum assistance would be ineffective and potentially harmful.
Choice B rationale
Cesarean delivery is recommended in cases of cephalopelvic disproportion when the fetus cannot safely pass through the maternal pelvis. This surgical intervention helps to prevent complications for both the mother and the baby.
Choice C rationale
Antibiotic administration is used to prevent or treat infections but does not address the mechanical issue of cephalopelvic disproportion, which is preventing the progression of labor.
Choice D rationale
Discharge to home is not a safe option when cephalopelvic disproportion is suspected. Immediate intervention is necessary to ensure the health and safety of both the mother and the fetus.
A nurse is caring for a client that has a new order for Laminaria for cervical ripening.The nurse provides education on this type of cervical ripener.Which of the following statements would the nurse include in the education?
Explanation
Choice A rationale
Laminaria acts by absorbing fluid from surrounding tissue and expanding. It is made from dried seaweed and is used for cervical ripening. The expansion of Laminaria dilates the cervix mechanically, which can be useful for procedures like abortion or labor induction. The absorbent properties help create a natural dilation process.
Choice B rationale
Laminaria is not used for an amniotomy. Amniotomy involves rupturing the amniotic sac, usually done with a specialized tool like an amnihook. Laminaria, on the other hand, is used for its mechanical dilating properties, not for breaking the amniotic sac.
Choice C rationale
Laminaria is not a prostaglandin. Prostaglandins are hormone-like substances used to soften and thin the cervix, usually administered as a gel or insert. Laminaria works differently by physically expanding rather than chemically altering the cervix.
Choice D rationale
Laminaria is not a tablet that is swallowed. It is inserted into the cervical canal to promote dilation. Its mode of action is mechanical expansion, which is different from oral medications designed to induce labor or ripen the cervix.
The nurse is observing a fetal heart tracing of a term pregnant client in spontaneous labor and observes excessive uterine activity.There are six contractions in 10 minutes over a 30-minute window and the fetal heart rate has changed to a category II tracing with late decelerations.The client has been repositioned, oxygen has been initiated, and an IV fluid bolus is infusing.The nurse anticipates an order for which medication?
Explanation
Choice A rationale
Terbutaline is a medication used to relax the uterus and reduce excessive uterine activity. It is a beta-2 adrenergic agonist that decreases the frequency and intensity of contractions. Administering terbutaline can help alleviate uterine hyperstimulation, improving fetal oxygenation and preventing further complications.
Choice B rationale
Hemabate is used to treat postpartum hemorrhage by inducing uterine contractions. It is not used to reduce excessive uterine activity during labor. Its primary function is to manage bleeding after childbirth, making it inappropriate for this situation.
Choice C rationale
Magnesium sulfate is used for neuroprotection in preterm labor and to prevent seizures in preeclampsia. While it can have some tocolytic effects, it is not the first-line treatment for reducing uterine activity. Its main role is in preventing eclamptic seizures and protecting fetal brain development in preterm labor.
Choice D rationale
Methergine is used to prevent or treat postpartum hemorrhage by causing uterine contractions. Similar to Hemabate, it is not suitable for reducing uterine activity during labor. Its primary purpose is to control bleeding after delivery, not to manage labor contractions.
A nurse is caring for a newborn immediately after delivery.Which of the following would indicate the newborn is showing signs of respiratory distress?
Explanation
Choice A rationale
A loud cry is a normal sign in a newborn and indicates good lung function and adequate oxygenation. It is not a sign of respiratory distress.
Choice B rationale
Grunting is a sign of respiratory distress in newborns. It indicates that the infant is using extra effort to keep the airways open and improve oxygenation.
Choice C rationale
Rooting is a normal reflex in newborns and is not indicative of respiratory distress. It involves the infant turning their head towards a stimulus when the cheek or mouth is touched.
Choice D rationale
Acrocyanosis refers to the bluish discoloration of the hands and feet in newborns. It is typically a normal finding and not a sign of respiratory distress.
Vasa previa is a rare obstetric complication.In order for this complication to occur, there has to first be an abnormality of which of the following structures of pregnancy?
Explanation
Choice A rationale
Amniotic membrane bands can lead to congenital anomalies but are not directly associated with vasa previa.
Choice B rationale
The amount of amniotic fluid can affect pregnancy outcomes, but it is not a contributing factor to vasa previa.
Choice C rationale
Vasa previa is a rare obstetric complication that occurs when fetal blood vessels cross or run near the internal os of the uterus. This condition usually results from an abnormal insertion of the umbilical cord.
Choice D rationale
Placenta accreta refers to the abnormal adherence of the placenta to the uterine wall, which is a separate condition and not related to vasa previa.
A nurse is assessing a fetal monitoring tracing of a client in labor at 39 weeks gestation.The fetal heart rate baseline is 105 bpm, absent variability, no accelerations, and no decelerations.What fetal heart rate category would the nurse communicate to the provider?
Explanation
Choice A rationale
Category 1 fetal heart rate tracings are considered normal and reassuring, showing a baseline rate of 110-160 bpm, moderate variability, and accelerations with no late or variable decelerations.
Choice B rationale
Category 2 fetal heart rate tracings are indeterminate and may show minimal or marked variability, but they do not have absent variability with bradycardia.
Choice C rationale
Category 3 fetal heart rate tracings are abnormal and require immediate intervention. They include absent variability with recurrent late decelerations, recurrent variable decelerations, bradycardia, or a sinusoidal pattern.
Choice D rationale
A reactive tracing shows accelerations of the fetal heart rate with fetal movement, indicating well-being. This scenario does not fit the description of a reactive tracing.
The nurse turns off the oxytocin infusion after a period of tachysystole.Which of the following outcomes indicates that the nurse's action was effective?
Explanation
Choice A rationale
A uterine contraction duration of 130 seconds is too long and indicates uterine hyperstimulation, which is not an effective outcome.
Choice B rationale
Uterine contraction frequency every three to four minutes is a normal and effective pattern, indicating that the nurse's intervention to stop oxytocin was successful.
Choice C rationale
The intensity of contractions being strong is important but does not directly indicate effective management of tachysystole.
Choice D rationale
Fetal flexed attitude refers to the fetal position and does not indicate the effectiveness of managing tachysystole.
A nurse is caring for a client who is 39 weeks gestation and in active labor.Your assessment findings reveal G1P0, BMI of 41, and completely dilated.The nurse observes a turtle sign after the head has delivered.What is the priority action by the nurse?
Explanation
Choice A rationale
Encouraging the patient to push harder during shoulder dystocia can worsen the situation by further impacting the shoulder against the pelvic bone.
Choice B rationale
Preparing for a cesarean birth is not the immediate priority action in the case of shoulder dystocia. Initial maneuvers should be attempted first.
Choice C rationale
Performing the McRoberts maneuver is the priority action. It involves hyperflexing the mother's legs tightly to her abdomen, which can help free the impacted shoulder.
Choice D rationale
Applying firm fundal pressure can worsen shoulder dystocia and should be avoided. Instead, suprapubic pressure can be applied to help dislodge the shoulder.
A nurse is caring for a nulliparous client at 39 weeks gestation who arrived at the OB unit with complaints of frequent, painful contractions for the last 12 hours.The nurse assesses the client and notes a category 1 fetal heart rate pattern and cervical assessment of closed, 50% effaced, and minus (-) 3 station.The client begins to cry and states, "I'm so exhausted.”. What nursing action would the nurse plan to implement?
Explanation
Choice A rationale
Promoting rest with a quiet environment and pain medication can help the client manage exhaustion and discomfort. Effective pain management and ensuring a restful environment can reduce stress and fatigue, allowing the client to conserve energy for labor progression.
Choice B rationale
Preparing for an emergency cesarean section is not indicated at this stage because the client's fetal heart rate pattern is reassuring, and the cervical assessment does not suggest immediate distress or the need for surgical intervention.
Choice C rationale
Notifying the client she will be NPO (nothing by mouth) is not necessary at this point, as the client is not in active labor and does not have an indication for an urgent surgical procedure that would require NPO status.
Choice D rationale
Asking the client to ambulate in the hallway for the next 2 hours may exacerbate her exhaustion. Since she is already exhausted and in pain, ambulation may not be the most appropriate intervention.
A nurse begins her shift on the obstetrical unit and observes several new admissions.The nurse understands the client with which of the following conditions would be a candidate for induction of labor?
Explanation
Choice A rationale
Preeclampsia is a condition that can pose significant risks to both the mother and baby if labor is not induced. Induction of labor may be necessary to prevent complications such as eclampsia, HELLP syndrome, or other severe hypertensive disorders.
Choice B rationale
Transverse fetal lie is a condition where the baby is positioned horizontally in the uterus, which makes vaginal delivery impossible. This condition requires a cesarean section, not induction of labor.
Choice C rationale
Vasa previa is a condition where fetal blood vessels cross or run near the internal opening of the uterus. This can result in severe hemorrhage if the membranes rupture, so a cesarean section is usually planned rather than induction of labor.
Choice D rationale
Active genital herpes poses a risk of transmitting the virus to the baby during a vaginal delivery. Cesarean section is recommended to prevent neonatal herpes infection, not induction of labor.
The nurse is providing care to a term client in labor with hypotonic uterine contractions.Which medical intervention does the nurse anticipate for this client?
Explanation
Choice A rationale
Preparing the client for an urgent cesarean section is not immediately necessary unless there are signs of fetal distress or other complications. Hypotonic uterine contractions may be managed with medical interventions to stimulate labor.
Choice B rationale
Discussing the client's gynecoid-shaped pelvis is irrelevant to the immediate management of hypotonic uterine contractions. While pelvic shape can influence labor, the focus should be on addressing the uterine contractions.
Choice C rationale
Amniotomy, or artificial rupture of membranes, can help to increase the strength and frequency of contractions in clients with hypotonic uterine contractions. This intervention can stimulate labor progress.
Choice D rationale
Keeping the client on bedrest is not a primary intervention for hypotonic uterine contractions. Encouraging activity and medical interventions to enhance contractions are more appropriate.
A nurse is caring for a client at 39 weeks gestation who is being admitted for an elective induction of labor.Cervical assessment is 4 cm, 80% effaced, minus (-) 3 station, soft consistency, and mid position.This indicates a Bishop score of 8. Which of the following induction methods does the nurse anticipate the provider will recommend?
Explanation
Choice A rationale
Amniotomy can be used for labor induction, but considering the client's Bishop score of 8 and the provider's recommendation, oxytocin may be more effective.
Choice B rationale
Oxytocin is a common and effective medication used to induce labor in clients with a favorable Bishop score. The client's cervical assessment suggests that she is a good candidate for oxytocin induction.
Choice C rationale
Cytotec (misoprostol) is used for cervical ripening and labor induction, but it is typically more appropriate for clients with an unfavorable Bishop score. The client's score indicates readiness for oxytocin.
Choice D rationale
Cervidil (dinoprostone) is another cervical ripening agent, but it is usually recommended for clients with a low Bishop score. The client’s score of 8 suggests that oxytocin induction is more suitable.
A nurse is caring for a client in labor and is completing an assessment at 0900.Which of the following actions should the nurse take? (Select all that apply.)
Explanation
Choice A rationale
Initiating an IV fluid bolus is a common intervention in labor, particularly if there are signs of maternal hypotension or fetal distress. However, it may not be the priority action in every situation, and the decision should be based on the specific clinical context.
Choice B rationale
Discontinuing oxytocin infusion is crucial if there are signs of fetal distress, uterine hyperstimulation, or tachysystole. Oxytocin, while useful for inducing and augmenting labor, can sometimes lead to excessive uterine contractions that compromise fetal oxygenation.
Choice C rationale
Notifying the provider is essential when any complication or unexpected situation arises during labor. The provider needs to be informed to make timely decisions regarding the management of labor and ensure the safety of both mother and baby.
Choice D rationale
Repositioning the client to a lateral position can improve uteroplacental blood flow and enhance fetal oxygenation. This simple intervention can be particularly beneficial if there are concerns about fetal heart rate patterns.
Choice E rationale
Titrating oxytocin infusion to 8 mu/min per order is an appropriate intervention if the goal is to maintain adequate uterine contractions. However, if there are signs of fetal or maternal distress, this action should be reconsidered.
You are caring for a term low-risk nulliparous client in the second stage of spontaneous labor.The client has an epidural and has been pushing for just over 3 hours and reports being exhausted.The fetal station is +3. What intervention do you anticipate the provider to recommend?
Explanation
Choice A rationale
Continuing pushing for at least 2 more hours is generally acceptable in the second stage of labor, particularly for nulliparous women. However, in this case, the client is exhausted, and the fetal station is +3, indicating that the fetal head is very low in the pelvis, suggesting the need for assisted delivery.
Choice B rationale
An emergent cesarean delivery with general anesthesia would be considered in cases of severe fetal distress or maternal complications. Given the fetal station of +3, a vaginal delivery is likely feasible, making this option less suitable in this context.
Choice C rationale
Vacuum-assisted vaginal delivery is appropriate when the fetal head is low in the pelvis (station +3), and the mother is too exhausted to continue pushing effectively. This intervention helps to expedite delivery while minimizing the need for a cesarean section.
Choice D rationale
Administering a fluid bolus of 1000 ml NS can be useful in managing maternal hypotension or dehydration, but it would not directly address the client's exhaustion or assist in delivering the baby.
A nurse is caring for a client during an amniotomy by the Certified Nurse Midwife.What is the nurse's priority immediately after the amniotomy procedure?
Explanation
Choice A rationale
Monitoring and assessing fetal heart rate immediately after an amniotomy is crucial to detect any signs of fetal distress, such as cord prolapse or changes in fetal heart rate patterns. This intervention helps ensure the baby's well-being following the procedure.
Choice B rationale
Assisting the client to the bathroom is not the priority immediately after an amniotomy. The focus should be on monitoring the fetal heart rate and maternal condition first.
Choice C rationale
Performing pericare is important for maternal comfort and hygiene but should not take precedence over assessing fetal well-being immediately after an amniotomy.
Choice D rationale
Documenting the color, odor, and consistency of the amniotic fluid is necessary for record-keeping and assessing for signs of infection or meconium. However, it should follow the immediate assessment of fetal heart rate.
A nurse is caring for a client that just delivered a 4,100 gram infant via vacuum-assisted delivery.The nurse identifies this client is most at risk for which of the following postpartum complications?
Explanation
Choice A rationale
Thromboembolism is a postpartum complication, particularly in women with risk factors such as obesity, immobility, or a history of thromboembolic events. However, it is not the primary risk associated with a 4,100-gram infant and vacuum-assisted delivery.
Choice B rationale
Postpartum depression is a significant concern for new mothers and can impact their well-being and ability to care for their newborn. While it is a relevant postpartum complication, it is not directly associated with the size of the infant or the delivery method.
Choice C rationale
Mastitis is a potential postpartum complication related to breastfeeding. It involves infection and inflammation of the breast tissue but is not specifically linked to the size of the infant or the mode of delivery.
Choice D rationale
Postpartum hemorrhage is the most significant risk for a client who delivered a 4,100-gram infant via vacuum-assisted delivery. The combination of a large infant and instrumental delivery increases the risk of uterine atony and trauma, leading to excessive bleeding.
You are completing the initial prenatal intake for your newly pregnant G3P2 client.She states her last labor ended in an emergency cesarean section due to cord prolapse.She asks if she would be a candidate for a TOLAC (trial of labor after cesarean). Based upon your assessment of her records, which of the following would be a contraindication for a TOLAC?
Explanation
Choice A rationale
History of preeclampsia is a consideration in future pregnancies, but it is not an absolute contraindication for a trial of labor after cesarean (TOLAC). Each case should be individually evaluated based on the severity and recurrence risk.
Choice B rationale
History of classical uterine incision during cesarean is a contraindication for TOLAC due to the increased risk of uterine rupture during labor. A classical incision involves a vertical cut on the upper uterus, which is more prone to rupture compared to a lower transverse incision.
Choice C rationale
History of cord prolapse is a serious complication, but it does not inherently contraindicate TOLAC. Future labor and delivery plans should involve close monitoring and readiness to address any recurrence of cord prolapse.
Choice D rationale
History of one cesarean section is not a contraindication for TOLAC. In fact, many women with a single previous cesarean delivery are considered good candidates for a trial of labor, depending on other factors and the type of uterine incision. .
The OB resident is assessing a client's cervix during admission for an induction of labor.The calculated bishop score is 4. Which of the following does the nurse tell the client regarding the start of her induction?
Explanation
Choice A rationale
A Bishop score of 4 indicates that the cervix is not yet favorable for oxytocin infusion. A higher score (usually 8 or above) is more indicative of readiness.
Choice B rationale
A Bishop score of 4 suggests that the cervix is unfavorable and will likely need cervical ripening to improve conditions for labor induction.
Choice C rationale
Pushing is only appropriate when the cervix is fully dilated to 10 cm and the baby is in the correct position, which is not indicated by a Bishop score of 4.
Choice D rationale
A Bishop score of 4 does not necessarily indicate the need for a cesarean section; it means the cervix is not ready for labor and may need ripening.
Immediately before an amniotomy, the external fetal heart rate monitor tracing shows a baseline of 145 bpm, moderate variability, and no decelerations.Immediately following the procedure, the tracing shows a fetal heart rate of 100 bpm, moderate variability, and recurrent variable decelerations.A moderate amount of clear, amniotic fluid is seen on the bed linens.The nurse suspects which of the following complications has occurred?
Explanation
Choice A rationale
Eclampsia involves seizures during pregnancy, which is not related to the changes in fetal heart rate seen here.
Choice B rationale
Umbilical cord prolapse is suggested by the sudden drop in fetal heart rate and variable decelerations following the amniotomy.
Choice C rationale
Placenta previa would present with painless bleeding and is usually diagnosed via ultrasound before labor begins, not through fetal heart rate monitoring.
Choice D rationale
Placental abruption typically presents with abdominal pain, uterine tenderness, and bleeding, not just changes in fetal heart rate and variability.
A nurse is caring for a client with gestational diabetes in active labor at 39 weeks gestation.The client required insulin to control blood glucose levels after hyperglycemia was persistent with diet and exercise changes alone.The client states "I often forgot to check my sugar levels, and I haven't checked them in the last couple days.”. The client had an estimated fetal weight (EFW) ultrasound one week ago with a result of EFW 4195 grams.What labor complication is this client at risk for?
Explanation
Choice A rationale
Prolapsed umbilical cord is less likely linked to gestational diabetes and large fetal size compared to shoulder dystocia.
Choice B rationale
Cervical insufficiency usually presents earlier in pregnancy and is characterized by painless cervical dilation, not directly linked to gestational diabetes and fetal size.
Choice C rationale
Shoulder dystocia is a common complication in cases of large fetal size (macrosomia) and gestational diabetes, as the baby's shoulders may get stuck during delivery.
Choice D rationale
Vasa previa involves fetal blood vessels crossing or running near the internal cervical os, which is not directly linked to the given scenario.
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